Euthanasia: are we ready for it?

Consider this. You’re diagnosed with a terminal illness. Certain death awaits you: no hope, no future. All you can look forward to is pain and death.

You have two options: either bear through the pain until you die, or have your doctor inject chocolate into your veins until it kills you – without pain, I might add.

I would choose death by chocolate. Which option would you choose?

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Death by chocolate is certainly the way to go. Image by Christi Neilsen via Flickr

If you answered the question, you just wasted your energy. You actually don’t have a choice: the only option is to bear through the pain until you die.

Euthanasia

Euthanasia – or assisted death by choice to end pain and suffering – is illegal in many countries; including Australia. There’s a huge ethical dilemma surrounding euthanasia, making it a difficult topic to tackle. But by observing countries where euthanasia is legal, we can see what it’s actually like.

Among the very few places where euthanasia became legal, Belgium and Netherlands stand out as having the longest history and experience. This makes them a good model for other countries to decide on whether they should legalize euthanasia. So, what do we see in these countries- namely, Belgium?

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Belgium- a great place to die. Image by Iwishmynamewasmarsha via Flickr.

What happens with Euthanasia?

Among the reasons for granting euthanasia, patient’s request is considered the foremost important factor. Physical and/or mental suffering, and no prospect of improvement are regarded as crucial in making such a decision. These are quite reasonable and well-defined criteria, which result in good outcomes.

Doctors observed family members’ grieving processes being more serene when they’re able to say their goodbyes: which they are able to do with euthanasia. They’re appreciative of the doctor’s decisions, even if they had prior uncertainties. From the standpoint of the patients who chose euthanasia, there are also benefits.

First, many of the patients whose requests are accepted have very little time to live. So there isn’t a huge impact on their lifespan. Second, there are psychological benefits which come with acceptance and control over death, such as: reduced anxiety, more appreciation of remaining life, a higher sense of spiritual accomplishment. Third, there were cases in which patients accepted treatment only on condition that its failure would be followed with euthanasia. It’s been reported, in one such case, the treatment having added almost a year to the lifespan of the patient.

Acceptance of euthanasia in Belgium has increased quite considerably since its introduction in 2002. Doctors are more confident in their decisions, and terminally-ill patients are more open to euthanasia. In view of all these, what are the concerns preventing other countries from adapting such a system?

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That’s not how euthanasia works! Image by Flood G. via Flickr.

Why are some people against Euthanasia?

“Slippery-slope” is the term that’s used. Once you introduce euthanasia to a certain group of people (i.e. the terminally ill), it may become accepted to the point where the law will have to expand to include more people. The terms ‘unbearable suffering’, and ‘dying’ – which are subjective terms- could become more and more lax; to the point where it includes people who could benefit from living. Therefore, the main concern surrounding euthanasia is that it could lead to unnecessary death. Although there are safeguards put in place to prevent such events, many remain speculative about their effectiveness.

A case of Euthanasia.

Allow me to finish up with a case-scenario. Identical twins, Mark and Eddy Verbessem, were both born deaf. They lived together their entire life, unmarried, and working as shoemakers in a small village in Belgium. As they neared 45 years of age, they were diagnosed with glaucoma- which would inevitably lead to complete blindness.  As their only means of communication was sign language, blindness would cause them to be unable to communicate with each other. They would need to be institutionalized, and won’t be able to see each other. This was unbearable for the twins. They were already worn out with other medical problems from their labor intensive job. So, they requested euthanasia. They were aware that many people were living death and blind, but they had nothing to live for. Would you accept their request?

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Talking about dying. Image by Social Innovation Camp via Flickr.

Spoiler alert: Their initial request was rejected, but after two years, it was accepted. The doctor believed that the psychological suffering was severe enough to justify euthanasia, but acknowledged that others may have different views than him.

The Belgian model continues to evolve; as it still has imperfections for which solutions are being developed. However, it is assuring to know that euthanasia in Belgium has received positivity among Belgians since 2002: as Belgians’ confidence in their health care system rose to second-highest in Europe. Other countries will definitely keep observing and learning from Belgium and who knows- one day, it may become just another normal medical procedure.

Want to learn more? “Questions and Answers on the Belgian Model of Integral End-of-Life Care: Experiment? Prototype?“, is a great article by Jan Bernheim, Wim Distelmans, and Arsene Mullie. They are doctors and researchers who have had first hand experience with palliative care in Belgium.

Note: There is actually no ‘medical’ way of death by chocolate. It is not used as a euthanasia, so don’t get your hopes up.

Edit: For those interested in ethics of difficult topics as such, Nelson has recommended a book called “Practical Ethics” by Peter Singer.

Edit2: For those interested in euthanasia, Tal has recommended a podcast called “Better Off Dead” by Andrew Denton.


13 Responses to “Euthanasia: are we ready for it?”

  1. Gorkem says:

    Thanks for the additional insight Tal. As you said, it has to be the patient who explicitly requests euthanasia for it to be even considered.
    Thanks for the podcast recommendation. Andrew was (when he was active in the media) a brilliant presenter. I am sure that his investigation into this topic is very valuable. I’ve added it to the post, if you don’t mind.

  2. Tal Cohen says:

    I can’t recommend Andrew Denton’s podcast highly enough. It’s 17 episodes long and he approaches all arguments for and against euthanasia in depth. He also visits Belgium, The Netherlands and Oregon (USA) where euthanasia is legal and being practiced in order to find out how their systems really work.

    Interestingly euthanasia was legal between 1996-1997 in the Northern Territory!

    To clarify a couple of things for those concerned: In Belgium and the Netherlands (can’t remember about Oregon, although the criteria for assisted dying are very tight) TWO doctors must independently sign off that the patient qualifies for euthanasia. It then goes before a review board. During all of this, the patient has to repeatedly state that they wish to die (both written and verbally) to the doctors.

    The main lobbyists against euthanasia are those who claim it will lead to elder-abuse (kids trying to kill off their parents) and to the abuse of the disabled (doctors/family determining they have no quality of life so they must be euthanised). Both of these arguments are real concerns, but if you look at those countries that have legal systems in place you can see what actually happens (hint: it doesn’t).

    Again, I can’t recommend Better Off Dead by Andrew Denton highly enough. You may need to intersperse it with podcasts of Hamish and Andy.

  3. Gorkem says:

    Thanks for sharing your experience Jinia. Irrespective of my moral views on euthanasia (or anyone else’s), I believe that people should have the choice to decide on what is best for themselves. Why should my moral views on right and wrong dictate the life a person I don’t know or understand? Doctors will be there to ensure that the patient is well aware of their situation (and future prospects), and will help the patient make a choice. This can only be achieved by doctors, not by laws.

  4. Jinia says:

    Such a controversial topic, Gorkem. I would like to know what is your personal opinion about euthanasia?

    In my country, this is definitely non-ethical, but the fact that someone may suffer and prefer to die than stay life is something that can’t be ignored. I have a personal experience when one of my relatives had ‘an unexplained illness’ and the doctor couldn’t help her. She chose to suicide. Maybe if there is a euthanasia option, she can spend a little bit more time with her family and have a proper goodbye.

  5. Gorkem says:

    Thanks Elizabeth and Nelson for your comments. There are certainly effective safeguards in place where euthanasia is legal (or as they call it in the U.S. – assisted suicide). But like everything that is regulated, there is always room for improvement; which is why the euthanasia laws are evolving in Belgium. But you cannot really know what safeguards you really need- for a specific country- unless you begin the process. Cultural norms do differ between countries after all. The question is, therefore, does euthanasia conflict with our culture here in Australia?

    As you have mentioned, there is a process akin to euthanasia in Australia. But it doesn’t really protect the doctors or nurses from prosecution. Sure enough, there have been cases where medication was discontinued without prosecution. But although this hastens death, patients still do suffer. On the other hand, there have also been prosecutions where those who granted the patient’s wishes were charged and imprisoned. The current situation keeps doctors vulnerable here in Australia. Unless it’s legal, there is no commitment and is thus, in reality- illegal. In other words, if you want it, you should put a ring on it.

    Thanks for the book suggestion Nelson. I have added to my post, if you don’t mind.

  6. Nelsongc says:

    Hi Gorkem,

    Great post. The ethical issue is one that i myself find fascinating to learn about. You mentioned about the “slippery slope” premise in your post. While i think this is very important to consider, i think it is evident that there are significant safeguards that could be implemented to prevent this occurring. Often this argument is used by people as a prevention to certain social change, and i think the countries and also certain US states that have this option have shown that it can be controlled.

    Another interesting point is the fact that, in a sense, euthanasia already occurs even in our own country. Called “passive euthanasia”, doctors often make the decision to give certain patients an excessive amount of medication or a drug (morphine for example) that in turn puts them out of their pain but is also a high enough dose that it actually kills them, or not give them necessary treatment to keep them alive. While it is slightly different in semantic meaning, it results in the same outcome due to the doctors passive choice.

    Also, if you haven’t read it already, i highly suggest reading the book Practical Ethics by Peter Singer, who has some very strong and logical views on the act of killing in the form of euthanasia.

  7. Elizabeth Newton says:

    I really have no idea why people have the free choice to participate in incredibly life-threatening activities for fun, but not the choice to end their chronic suffering through euthanasia.

  8. Gorkem says:

    Thanks for your comment Claire. I was hoping someone would draw attention to ‘choice’. There are certainly many dilemmas surrounding euthanasia, but we do have to think about an individual’s right to make decisions concerning their self. Something, I believe, that is lacking in many of the discussions regarding euthanasia.

  9. Claire MacGregor says:

    Very interesting topic. It’s unfortunate that terminally ill people do not have a choice to end their pain and suffering in Australia. Obviously there are many controversial issues and moral dilemmas raised with euthanasia which need serious attention, but at the end of the day I believe people in this situation deserve a choice. It would be nice to see Australia follow in the footsteps of countries such as Belgium.

  10. Gorkem says:

    That’s an excellent point Jacob. How do you know if a person is in the right state of mind in making such a decision? Allow me to quote Luc Bovens on this topic:

    “What is it for a person to be capable of discernment? We need to identify features of a decision that are indicative of capability of discernment in the context at hand… I propose that what makes a decision authoritative is (1) that the decision is responsive to reasons and (2) that the agent is the author of her decision… I take these to be the features that are indicative of capability of discernment and that warrant the authoritativeness of the decision.”

    The key here, I would say, is being responsive to reasons. The decision that lies on the doctor is whether that reason presented by the patient is reasonable. Whether it’s a mental illness or a physical illness, a doctor would not approve euthanasia if there is cause for improvement. So they base their decision on how unbearable the “suffering” is. The issue with this is that suffering is subjective. It is easy to understand and emphasize with the suffering of a physical pain. ‘Aching pain’, ‘burning pain’ – we all know what it feels like. But what is the pain felt in a mental illness? I guess it is indeed a difficult area.

  11. jacobg says:

    A very interesting piece and I would say that I would agree in theory with the introduction of some form of euthanasia policy, but it is certainly a very complex issue. I find it hard to imagine a scenario when euthanasia could be justified for mental illness, just on account of the fact that it would be/is difficult to be sure that the person is in the right state of mind to be able to make the decision. I have had a little to do with mental illness and I think that it is dangerous ground introducing euthanasia into that area. But in other case if the checks and balances are right I certainly support it.

  12. Gorkem says:

    Thanks for your question Jenny. Here are the checks:

    1 The attending physician has come to the conviction that the request from the patient is voluntary and well considered.

    2 The attending physician has come to the conviction that the suffering of the patient is unbearable and without prospect of improvement.

    3 The physician has informed the patient about his or her situation and prospects.

    4 There are no more reasonable alternatives for the patient.

    5 The physician has consulted at least one other, independent physician.

    6 The physician has terminated the patient’s life or provided assistance with suicide with due medical care and attention.

    As you can see, these are very subjective points. It puts quite a lot of pressure on the physicians- so they might be reluctant to approve cases. But with time, physicians have become more confident in their ability to make a judgement, after not being sued that is. This now raised a different concern. Are doctors approving euthanasia in patients who could have been saved? Some say yes, others say no, many fear the possibility.

  13. Jennifer Robertson says:

    Hi Gorkem,

    Thanks for an interesting post.

    Andrew Denton did a pro-euthanasia podcast series called better off dead. I haven’t listened to it, but I read about it here http://www.smh.com.au/entertainment/tv-and-radio/andrew-denton-is-back-with-better-off-dead-a-podcast-about-the-right-to-die-20160218-gmxr1j.html. One of the points that he talks about is the series of checks and balances that an applicant needs to go through to be approved for euthanasia, in this case for the Netherlands, only one third of applicants are approved in this system. Do you know what these checks involve?

    Jenny